Browsing by Author "Holguin, A"

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Fortalecimiento de las políticas de salud pública contra el cáncer infantil: logros de Perú en el marco de la Iniciativa Mundial de la OMS contra el Cáncer Infantil
(Pan American Health Organization, 2023) Maradiegue, E; Pascual, C; Vasquez, L; Maza, I; Ugaz, C; Montoya, J; Zapata, A; García, H; Chavez, S; Ordoñez, K; Rossi, J; Diaz, R; Morales, R; Trigoso, V; Ames, R; Celis, E; Barzola, I; Torres, L; Cosme, M; Tarrillo, F; Rojas, N; Santillan, C; Quispe, Y; Palacios, V; Godoy, V; Tello, M; Tarco, D; Wachtel, A; Malaver, E; Diaz, E; Goyburu, M; Perez, V; Talavera, I; Baca, ME; Maza M; Saldaña, L; Holguin, A; Jarquin, M; Loggetto, P; Metzger, M; Friedrich, P; Lam, C; Rodriguez-Galindo, C
Objective. To report the progress in Peru, since June 2019, in the implementation of the World Health Organization Global Initiative for Childhood Cancer using the CureAll framework, which can be replicated in low- and middle-income countries. Methods. A mixed method was used of participatory and documentary evaluation. The participatory evaluation included stakeholders from various government institutions, nonprofit organizations, and international partners. The documentary aspect consisted of a review of data on the regulatory environment, national projects, and interventions implemented. The Ministry of Health engaged more than 150 participants to form working committees, which have developed policy and regulatory documents to strengthen care services. Results. Achievements include a decrease in the national treatment abandonment rate from 18.6% to 8.5%, the approval of the Childhood Cancer Law, improvements in the management of patients with febrile neutropenia, and a reduction in rates of events of clinical deterioration and mortality of hospitalized patients. The Cure All implementation framework allows local teams to implement specific strategies and monitor early outcomes in pediatric oncology. Conclusions. The results obtained reflect the teamwork, the leadership of the authorities, the technical support of professionals, and the support of involved organizations. Further actions will be needed to guarantee sustainability, and monitoring tools are needed to assure success in the planned activities.
Treatment outcomes of patients with classic and AIDS-related Kaposi Sarcoma: a single-center real-world experience
(Springer Science and Business Media Deutschland GmbH, 2023) Valcarcel-Valdivia, B; Enriquez-Vera, D; Piedra, LE; Holguin, A; De-la-Cruz-Ku, G
The recommended first-line chemotherapy agents for managing Kaposi sarcoma (KS) in high-income countries are expensive and often unavailable in developing nations such as Peru. Limited data exist on whether management practices in these countries affect patient outcomes. We assessed the real-world treatment approaches and outcomes of patients with KS in Peru. We retrospectively reviewed the medical records of patients with acquired immunodeficiency syndrome-related KS (AIDS-related KS; n = 95) and classic KS (CKS; n = 81) diagnosed at a tertiary center between 2000 and 2014 in Lima, Peru. We used the Kaplan–Meier method to estimate overall survival (OS) rates. The median follow-up was 64 months for AIDS-related KS and 88 months for CKS. The median age of patients with AIDS-related KS was 35 years (range 20–63 years) and 70 years (range 33–91 years) for those with CKS. Most individuals had an Eastern Cooperative Oncology Group performance status of ≥ 2 (AIDS-related KS 75%; CKS 85%). Seventy-six percent and 40% of individuals with AIDS-related KS and CKS, respectively, received systemic chemotherapy. The most common first-line drug was paclitaxel, with relatively optimal overall response rates (ORRs) for AIDS-related KS (n = 64/72, 89%; ORR 61%) and CKS (n = 24/32, 75%; ORR 50%). The 5-year OS rates were 71% in the AIDS-related KS cohort and 81% in the CKS cohort. The findings from this real-world study may inform clinical practices and highlight the need for increased access to effective treatments and clinical trials for patients with KS in Peru and other developing countries.
Una estrategia multimodal para mejorar la atención médica de pacientes pediátricos con cáncer y fiebre en Perú
(Pan American Health Organization, 2023) Mendieta, A; Rios-Lopez, L; Vargas-Arteaga, M; Maradiegue, E; Delgadillo-Arone, W; Rueda-Bazalar, C; Holguin, A; Santillan-Salas, C; Maza, I; Homsi, M; Farias-Barrios, F; Assayag, C; Vásquez, L; Pascual, C; Caniza, M
Objective. The DoTT (Decreasing Time to Therapy) project aimed to minimize the interval between fever onset and medical interventions for children with febrile neutropenia. The objective of this study was to determine the effect of implementing the DoTT project on the hospital time to antibiotic (TTA) and patient time to arrival (PTA) at the hospital in children with febrile neutropenia admitted to the emergency department. Methods. The DoTT project was implemented at a Peruvian hospital and followed the World Health Organi‑ zation (WHO) multimodal improvement strategy model. Components included creating a healthcare delivery bundle and antibiotic selection pathways, training users of the bundle and pathways, monitoring patient out‑ comes and obtaining user feedback, encouraging use of the new system, and promoting the integration of DoTT into the institutional culture. Emergency room providers were trained in the care delivery for children with cancer and fever and taught to use the bundle and pathways. DoTT was promoted via pamphlets and posters, with a view to institutionalizing the concept and disseminating it to other hospital services. Results. Admission data for 129 eligible patients in our registry were analyzed. The TTA and PTA were com‑ pared before and after the DoTT intervention. The median TTA was 146 minutes (interquartile range [IQR] 97–265 minutes) before the intervention in 99 patients, and 69 minutes (IQR 50–120 minutes) afterwards in 30 patients (p<0.01). The median PTA was reduced from 1483 minutes at baseline to 660 minutes after the intervention (p<0.01). Conclusions. Applying the WHO multimodal improvement strategy model to the care of children with febrile neutropenia arriving at the hospital had a positive impact on the PTA and TTA, thus potentially increasing the survival of these patients. © 2023 Pan American Health Organization. All rights reserved.